Book reviews

J. S. Bajaj (Ed.): Insulin and Metabolism. Amsterdam/London/ New York: Elsevier/North Holland; Excerpta Medica 1977. Pp. 296, US $ 39,95, Dfl. 100.00. One would expect a book of this title to offer a well-balanced summary of the present state of knowledge on the central role of insulin in metabolism. The first five chapters are well written and cover the functional organisation of the Islet, insulin synthesis, secretion and degradation, and insulin receptors. However, rather than progressing from this sound base to cover the mechanism of insulin action, we have to make do with a small chapter on insulin and protein turnover. In the remainder of the book there are good reviews on the insulin responses to a glucose load at stages in the evolution of diabetes, the postulated role of insulin in atherogenesis, and an excellent summary of current research on glucagon. It is a pity, therefore, that these are interspersed with contributions whose subject matter has only minimal relevance to the title of the book. These latter articles occupy more than one third of the available space which could more appropriately have covered such subjects as insulin structure in relation to its function (mentioned only briefly in the chapter on biosynthesis), the interactions of insulin and other hormones in intermediary metabolism, and the wide subject of exogenous insulin and its use in treatment. Even by current standards this is an expensive book and, combined with the deficiencies mentioned, it is doubtful that many will consider it a justifiable investment. L.J .P. Duncan (Edinburgh)

lieve it to be coi An opportunity foon occurred of fubmitting this opi.
sft of aftual experiment, by the re-ap^ pearance of the >ne of the two patients who had been fubjedted to this atttx learly about the fame period, in the preceding year. 1 " Mrs. H. had, for a few weeks previous to the prefent attack, been occafionally fubjed to flight febrile paroxyfms, for which bark, &c. had been prefcribed, but were never diligently employed. " Towards the evening of the 28th July, lhe was feized with giddinefs and head-ach, a fenfe of great laflitude and weaknefs, with other precurfory fymptoms of fever. On the following morning, her ikin was preternaturally hot; pulfe frequent, weak, and irregnlar; head-ach rather more violent; refpiration fomewhat opprefled; was thirfty, but not coftive;vher tongue parched, but not foul. She had pafled a reftlefs and uneafy night, and faid, that fhe now apprehended the nature of her difeafe would prove fimjlar to that which (he had experienced lall year. In the evening, a fingle veficle appeared on the thigh. " 30th. She had been equally reftlefs as on the foregoing night; and to an aggravation of the former fymptoms were now fuperadded, great irritability of the fyftem, and frequent, but irregular fhiverings. In the courfe of the day, five more veficles made their appearance on different parts of the body. " Auguft I. A fmall one appeared on the exterior part of the meatus auditorias. By the evening of the next day, all the febrile fymptoms had fuffered a confiderable abatement; but fhe continued, for a few days, affedted with much languor and debility; had a flight exacerbation of fever every night, with an evident apyrexia in the morning. Towards t>rs! Duncans' Annals of Medicine for 17 99. 553 " Towards the decline of the complaint, an eruption of final! pimples came on, efpecially about the neck and arms, fimilar to thofe excited by nettle burning; but which foon went off, without any bad fymptom. The difeafe was mild, in comparifon with that file had fuftuined in the. preceding year, and fhorter in the term of its duration. The Veficles were few in number, and wholly confined to the external furface of the body. Thofe that did appear, were filled, however, in like manner, with a yellowifh ferum, and of the fame magnitude as on the former occafion. They were painful upon being touched, but the circumjacent ffcin was not much' inflamed. Of two or three that were pundlured, fhe complained a good deal, and obferved, that her fenfations after the operation, were fimilar, as fhe conceived, to what would have been felt by her upon the application of any corrofive or cauftic matter to the fame part of the body. Upon the moft diligent fcrutirty, I could not dilcover that any perfon, either in the town or neighbourhood, had been affe&ed with a fimilar complaint; nor was the difeafe comma-, nicated to any one, although, both now and in the preceding attack, the patient had, at my particular requeft, continued to allow A perfon to fleep with her during the whole period of her illnefs. " Both during the progrefs, and at the height of the difeafe, fbme of the fluid with which the veficles were filled was taken, and with it I inoculated myfelf and two other perfons, in both arms* making three pun&ures in each arm. In one of the patients, on the day after the infertion of the matter, a fingle puntture exhibited a very flight degree of inflammation; not, however, more than what frequently occurs from a fcratch or pundlure made with a clean inftrument: But neither in this patient, nor in the other two, was any conftitutional effeft, or the leafl: perceptible indifpoiition, produced. The refult of thefe attempts to communicate the difeafe, by inoculation and contaft, although not perhaps fufficiently numerous to prove decifive of the queftion, is at leaft extremely unfavourable to the hypothecs of thofe who affert the contagion's nature of pemphigus, and tends firongly to fupport and confirm the negative conclufton.

"
From the foregoing ftatement it would appear, that the following inferences may be fairly deduced. " ift, That pemphigus i? a difeafe of which perfons are fufceptlble more than once in the courfe of their lives. " zdly, That'the difeafe originates where no fource of infe&ion Can poffibly be difcovered, and. feems generally connected with more or Iefs of an affe&ion of the whole fyftem. " 3dly, That patients labouring under it may have conftant intercourfe with others, and yet never communicate the difeafe to any of them. " 4thly, That the difeafe is not communicable, like the cowpox or fmall-pox, by inoculation. " On the whole, when we comprehenftvely furvey the evidence recorded by recent writers on the fubjeft, as well as that furnifhed fry the prefent and former cafes, we mult, I apprehend, be neceffarily 554 Dr$. Duncans' Annals of Medicine for 179$.
farily led to conclude, that the pemphigus major of Sauvages is an affeftion merely fpo'radic, and not of" a contagious nature. " That the fymptoms accompanying one or other inftaaces of this affe&ion, are thofe which attend febrile difeafes, whether inflammatory or putrid, the cafes given by Drs. Dickion and Stewart^ and the one recorded by Mr. Chriftie, fufficiently evince. In practice, therefore, it would appear, the moft important diftinctions are, to afcertain, " ift, When the fever is of an inflammatory nature, and accompanied with ftrong and increafed adtion of the vafcular fyftem. " zdly, When the fever has a tendency to the typhoid type; is marked by great debility, and fymptoms which denote a tendency of the fluids to putrefa&ioa. In the ?rft cafe, it will be obvious, that evacuation and other antiphlogiftic remedies, fuited to the nature of the cafe, will be proper. As, on the other hand, in the fecond, it will be equally neceilary to ftflin all evacuations, and to employ thofe remedies alone which fupport the ftrength, and give tone and vigour to the fyftem. ** From the whole concourfe of fymptoms, in the ?refent, and in the two cafes of this affedion formerly communicated, we ar? naturally led to infer, that the difeafe, in a great meafure, depended on a certain ftate of debility, and a tendency of the fluids tcj putrefaction.
" The general indications of cure thence deducible, are fufficiently obvious.
"'In the cafe now under confideration, on the firft acceffion of the complaint, when the fkin was hot and dry, a mild antimoniaj was exhibited, in order principally to excite a gentle diaphorefjs j but its ufe was foon difcontinued. " Afterwards, opiates combined with vitriolic asther were foun4 very ufeful in diminilhing the effefts of irritation, and in promoting the determination to the furface. The bark and other topics, particularly the nitrous acid, in a ftate of proper dilution, were early adminiflered, and proved very efFe&ual in obviating the effects of debility. By thefe means, and the ulterior employment of other auxiliaries, the health of the patient was fpeedily re-eftabliihed." n VII. Hijiory of a Cafe, terminating fuccefsfully, in nvbicb an inn verted Uterus nxias extirpated. By Mr. Alexander HunteR, Surgeon, Dumbarton.
We pafs over the firft part of this cafe, and only prefeni out readers with the conclufion : " When the womb firft came ?down, it was nearly of the fi?e of a fmall pine-apple, and felt hard. The fecond time it was fmaller, but ftill harder. Before returning it into the vagina, a trial was always made to reduce the inverfion of it; but after the firft time^ the fundus was only dinted by. any* force that could be ufed. " The profpeft before the patient was now deplorable. The reftoring Dfs, Duncans* Annals of Medicine for 1799. 555 reftoring the uterus was abfolutely impracticable; and, if allowed to remain in its prefent fituation, it muft be very diftreffing. " About a fortnight elapfed in this way, when a new fet of fymptoms took place. A difcharge of a thin watery nature began to flow from the whole furface of the womb, which gradually increafed in quantity, and became fo extremely foetid, that it was very difagreeable to enter the room. And, though great attention was beftowed, the bed was always wet. Her ftrength was foon much reduced. And, notwith(landing a liberal ufe of bark, elix. vitriol, and port-wine, fevere heftic attacks came on. " In this ftate of the bufinefs, no plan could be figured for faving the patient, without amputating the uterus. Every endeavour I had ufed for procuring information, either from medical men or books, left me ftill in the dark; as in every cafe of inverfion mentioned, not one was to be found, where the patient had furvived for any time, unlefs the womb was dire&ly returned. But, after confidering that the organ was not immediately neceftary to life ; that very extenfive wounds, even in its diftended ftate, has been made without any ill fymptoms; and that, in its prfcfent fituation, the funftions were for ever deftroyed ; indeed, that it was now only a burdenfome mafs; and the woman herfelf wifhing eagerly to be relieved from the miferable way fhe was then in, it was determined to extirpate it. te I began the operation, by fixing a ftrong ligature on the neck of the tumor, clofe to the os externum. But being fearful of fpafmodic affeftions from this compreffion,' I waited fix hours without proceeding farther. During all that time, however, no complaint was made, no pain was felt.
" With a fcalpel the whole uterus was then cut off", clofe to the ligature. Still neither fymptoms of pain, nor even uneafinefs, were perceived. And, I believe, the operation was over before the patient knew it had been begun. She was then laid to reft, and an opiate adminiftered. ^ " During the night (he flept well; and, next morning, was very much refrefhed. The hettic fymptoms went off; her appetite returned ; and, in fourteen days, fhe was able to get out of bed. At the end of a month fhe was perfedtly recovered. Drs.jDunctrm1 Annals of Medicine for 1799* f< Some months after this cafe happened, I gave the uterus td l)r. Jeffray, of Glafgow, who, I believe, ftill has it." XII. Obfewations on the Benefit derivedfrom the Application of col4 Water, in Cafes of Scarlatina Cynanchica. By Dr. Geo. Mosmak, Vhyfician, Bradford. ' ' 1 1 " A boy, eight years of age, on the.31ft of July laft, was feized with great laffitude, with rigors, fucceeded by extreme heat, thirft, fore throat, and every fymptom chara&eriftic of that fpecies of pyrexia, denominated Scarlatina Cynanchica? v " On the following day, the apothecary to the family was confulted, and prescribed an emetic, which operated well. He was then direfted an aperient folution, which procured him feveral evacuations, without any abatement of fymptoms.
(C On the morning of the 2d of Auguft, when I vifited him, the whole furface of his body was covered with a fcarlet eruption. His tongue was dry, and exhibited a fur approaching to black; the internal fauces were confiderably tumefied, and were of a deep red colour; his eyes had the appearance of an incipient fufFufion upon the tunica albuginea; his pulfe beat 135 ftrokes in the minute ; his urine was fcanty, and Angularly pale. " I had not an opportunity of applying to him the thermometer, but his lkin felt intenfely hot.
Drs. Duncans* Annals of Medicine for 1799. 557 bf his child, and which might probably obviate the danger of con-.tagion in a very numerous family. v " When I firft vifited my patient he was under the influence of the hot ftage, and there appeared not the fmalleft tendency to its folution by perfpiration. I therefore introduced into his chamber a free current of air. I then diredled him to be placed in the middle of the floor, and the Whole furface of his body to be fpcnged with cold vinegar. " I faw the operation performed ; and although he was at firft much averfe to it, yet he felt it fo cooling and refreftiing to him, that he never afterwards objected to a repetition of the, experiment. The attendants, therefore, had reeourfe to the application as often as he felt hot, or appeared to them to be fo, and with the moil beneficial effedts. But they had the ftridteft injundlions, not to hazard the application, when he had. the leaft chillnefs upon him, or when there was the fmalleft tendency to perfpiration. In either of thefe C^fes, I conceive the pradtice to be highly dangerous; but during the hot ftage of fever, I have uniformly found, that the application of cold liquids reduces the frequency of the pulfe, and increafes the ftrength. It has alfo a wonderful effedt in obviating the tendency to delirium, in diminifhing thirft, in increafing the eflforefcence of the fkin, and in inclining it to a gentle moifture. " In the prefent cafe, thefe effedts were Itrikin'gly exhibited indeed. __ , " Prom the apparent violence of the attack, and the early period at which the moft alarming fymptoms made their appearance, I had every reafon to prognofticate the approach of delirium, accompanied by thofe phenomena which precede the Iaft cataftrophe. On the morning, however, of the fourth day of fever, I found that he had had a good night, and was then very Compofed. His tongue-was moift; his pulfe reduced to 120 ftrokes in the minute; his Ikin felt foft, and the febrile heat was much diminiihed. " I Ihould have obferved, that from the firft of my attendance, I had diredled him to have a table fpoonful every hour, of equal parts of aq. ammon. acetat. et aq. fontan. Arid the attendants were inftrudted to give him a fpoonful or two, occafionally, of the opening folution already mentioned, fo as to keep the bowels in a ftate of folubility. His common drink was cold water. " This morning there appeared a little floughnefs on the tonfils ; and I ordered him a gargle with meI. rasa et hordeat. acidulated .ftrongly with the nitrous acid. The cold applications were conftantly ufed on the approach of the hot ftage 4 and to each dofe of his julep, a few grains of nitre were added. " During the whole of this day, he continued to derive relief from this pradtice ; and, on the morning of the 5th, his urine was nearly the colour of bright water. His tongue was clean and moift; his pulfe 105 ; the floughs in his throat had difappeared ^ and from this period he recovered rapidly. " Seven of the family were fucceflively feisccf with the fams Nvmb. XVT. Cccc fpecies Drs. Duncans' Annah of Medicine for 1799.

"
In one of the cafes, the moll ferious confequertces were manifcllly combated fuccefsfully by the practice defcribed. In no inftance was the fever protrafted beyond the 5th or 6th day. " I have thus Sketched the molt prominent features of a folitary cafe of fcarlatina, cured by the ufe of cold applications ; and were it neceffary to eftablifh the efficacy of the practice, I could adduce a very considerable number. " During my attendance on this family, I caught the contagion. The fymptoms of fcarlatina were diftindtly and rather ftrongly marked; but by the timely application of a Ihower-bath, twice a day, the febrile affe&ion was fpeedily removed. I took no medicines.
" If the good effe&s of this pra&ice be deducible from the cold produced by the procefs of evaporation, are there not other applications which would more effe&ually and powerfully accomplifh the objedt propofed ?" XIV. Medical Cases\ by Jo mi Haxby, Phyfician, Pontefraft.
3. A cafe of enlargement of one of the fpinal vertebras, gradually difappearing on an enlargement of the trochanter major of the right thigh, which was fucceeded by hydrocephalus, terminating fatally. " W. S. aged nine years, had for fome time laboured under immobility of the lower extremities, with conftipation of the bowels, and a degree of dyfuria; owing to an enlargement of one of the fpinal vertebrae.

*'
Cauftics were applied to each fide of the prominence, and kept open fome time ; during which there was a flight alleviation of his complaint. But as the amendment was not in proportion to his expeftation, nor equivalent to the facrifice of his eafe from the irritation of the cauftics, about two months after their infertion he allowed the ulcers to heal. " Very foon after this, the trochanter major of the right thigh bone began to be enlarged ; and in proportion as it increafed in bulk, the difeafed fpinal vertebrae was diminilhed, till at laft there was no inequality in the appearance of the fpine. " The trochanter continued to be enlarged for about a month; though great pains were taken to reduce the fwelling by fridtion with fpirituous embrocations, which was at length effected j and now he could walk with perfe6t eafe, as far as could be expe&ed from his reduced ftrength ; but he foon began to complain of pain in his head, which became more and more violent, fo that when I faw him, {which was about a week after it had come on) he appeared to have every fymptom of hydrocephalus internus, except ftrabifmus, which fupervened in a day or two, when he died.
te Was the hydrocephalus, in this cafe, at all connetted, as caufe and effett, with the previous enlargement and fubfequent diminution of the trochanter major and fpinal vertebra I?Would the timely re-infertioa of the cauftics have prevented hydrocephalus?'* This comprehenfive and elaborate work commences with an account of the diverfity of opinions refpetting the caufe and origin of peftilence. The author then prefents his readers with hiftorical views of peftilential epidemics, and the phenomena in the phyfical world which preceded, attended, or followed them, from the earlieft accounts down to the year 1798. Thefe fubjetts occupy the firft volume.
The fecond volume begins with a tabular ftatement of the bills of mortality for the two laft centuries, whith the author introduces thus: * " Our accounts of difeafes and the phenomena of the world, which appear to be connected with them, are altogether imperfeft. But in the two laft centuries we have a tolerable hiftory of difeafes, and occafionally an account of the feafons and remarkable occurrences.
In the following tables the reader will find the bills of mortality for London, Augfburg, Drefden, Bofton, one church in Philadelphia, with the bills of a few years for Paris and Dublin; to which are prefixed fuch of the remarkable phenomena of the elements as I have been able to colled. " As winter makes a part of two years, the word severe is fet againft the year in which the winter began. Thus, againft the year 1607, the word severe refers to the winter of 1607-8. The blanks denote, either that nothing lingular occurred in thofe years, or that I have no account of the occurrences. Further enquiries might probably enable me to fill many of thofe blanks. " Bills of mortality do not exhibit a complete view of epidemics, as fome of the moft remarkable, efpecially influenza, aeftroy but few lives; and the bills of the years when that difeafe alone prevailed, are remarkably low. It is often the immediate precurfor, in fpring, of peftilential difeafes in autumn, in which cafes the bills of the .year are very high." The fecond volume alfo contains remarks on the tables; on peftilential periods; influenza ; on the order, connection, and progreffion of peftilential epidemics; on the extent of a peftilential ftate of air; conjectures on caufes; means of prevention, &c.
Considerations regarding Pulmonary Consumption. By Thomas Sutton, M. D. JVIember of the Royal College of Phyficians, and Phyfician to the Forces; ?vo. pp. 120. London, Robinfons. The leading objeCts of Dr. S. in this pamphlet appear to be to invalidate the common opinion refpeCting the caufe of emaciation and death in phthifis. Obferving that many patients die of thi$ difeafe, when attended with very little cough or expectoration, and certainly, with no -marks of purulent expectoration, he concludes that the fymptoms often depend on fome other caufe. In fuch cifes, he thinks the caufe of death " is fuch a dpcreafe of the ftimulating quality of the blood, as at laft to render it incapable of continuing the circulation. This inference is fuppojted by the appearance of the blood drawn, which contains a very fmall proportion of craflamentum." < At p. 19, Dr. S, give? the following opinion, viz. " It may not be improper in this place, to ftate an opinion regarding the fource of thofe happy feelings, high fpirits, and that conftant hope of a favourable termination of the difeafe, which have been obferved to attend confumptive patients. " Pleafant and exhilirating fenfations are, I believe, common to all perfons under a certain ftate of debility from difeafe ,unconneCted with uneafy feelings. They may be occafioned by the common ftimuli of intellectual exertion, of the circulation of the blood, of" food, &?. upon the debilitated body; as it is evident, that the fame ftimulus has a greater effeCt upen perfons debilitated by djifeafe, where no powerful agent continues to occafion further debility, than, ceteris paribus, upon thofe who are in health. I have experienced fuch fenfations after two fevere fits of typhus fever, when, being very debilitated, I had the lame pleafurable fenfations (Dr. Darwin's expreflion) as if I had been in cheerful company in health, and had drank moderately of wine. But ftriking inftances of fuch effects from debility are obferved by medical practitioners, in patients who have been tormented by inflammations in the bowels,, which have ended in gangrene. In fuch cafes, ;t has often been obferved, that patients are in remarkably good fpirits, and cannot be readily convinced that they are in any danger. Thefe feelings are occafioned by debility, brought on by ficknefs, pain, want of fleep and of food, which is aCted upon by the common ftimuli of intellectual exertion, of food, of the circulation of the blood, &c. and have the effect, in the way related, of producing a confiderable degree of cheerfulnefs, though unhappily of fliort duration. This cheerfulnefs and hope is more obfervable in phthifical patients, becaufe the difeafe is of confiderable duration, and becaufe the debility gradually increafes; and the patients, at leaft ten hours in the day, are, during the greater part of their difeafe, free from uneafy fenfations. Bqt, while affeCted with pain, or tormented with the irritation of H^at in the night, paroxyfms of heCtic fever, t;here is ho more cheerfulnefs and refi'gnation in them, than in people labouring under equally "unpleafant fenfations in other difeafes." In Section IV. the author ftates his own caufe of phthifis, which is, an ohstru&ion in the mesenteric glands. This hypothecs he fupports by cafes, and reafoning. We believe with Dr. S. that tales* mesenterica and phthifis are often combined ; but we alfo believe that they may exift independently of each other, which he appears to doubt; for, at p. 31, he fays: " Hence it appears to me, that phthifis pulmonalis is caufed by a difeafe in the mefenteric glands, and that the tubercles in the lungs,, and fome other of its fymptoms, are excited by fympathy.?' Seft. VI. contains " General obfervations refpedting the adHou ?f fympathy in confumption. VII. Predifpofition. VIII. Caufe of emaciation and debility, IX. On heftic fever;" the caufe of which, Dr. S. believes to be, " an obftru&ion of the perfpiratory organs arifing from the defe&ive circulation." XIII. On the Cure.
When Dr. Warren looked into any ne\y medical work, which he had feldom leifure to do, he firft examined the method of pure ; and if he found nothing new there, he fearched no farther. Our author recommends the ufual remedies, fhough he explains their operation fomeu hat differently from hi$ predeceflbrs. Emetics feem to be his favourites, as they were of Drs. Symonds and Reid. The pamphlet is concluded by an Appendix, containing ten Cafes, examined after death, which tend to confirm the author's opinions. Though we obferve feveral inaccuracies, and what we deem errors, in the above work, we are neverthelefs convinced that it is well calculated to improve the theory and treatment of this important difeafe.
A Jhort Account of the InfeSiious Malignant Fever, as it appeared at Uxbridge, and its vicinity, in the Summer and Autumn of the year 1799 ; with a detail of the good effeSis of Ytafi and ITital Air, in the different ft ages of that DiJ'order. By a Medical Practitioner. 8vo. pp 50. price is.6d. We are forry that the ingenious author of this pamphlet has not given his name to it; for medical fadls generally require all the aid they can derive from the authentication of a name.
The difeafe appears to have been the cynanche maligna in its worft form, and highly contagious among the poor. The fymptoms agree with thofe defcribed by other writers, but in the cure the author fays: " The manner in which I have ufually adminiftered the yeaft, has been, by putting a tea fpoonful, .or more, according as it agreed with the llomach, into a quart bottle, and filling it up with mild porter: of this the patients took a glafs full, every hour, or oftener, if they were thirfty. " I have found it particularly ufeful in a great number of cafes; and, therefore, I cannot avoid recommending it as a rnoft powerful antifeptic, in malignant fevers. I have generally given it from jthe beginning, and perfifted in its ufe, till a reftoration to health fook place.
?' But Mr. Kirwan's Essay on Mineral Waters. " But there is another remedy, not ufually recommended in this diforder, that I have found particularly ferviceable, viz. the oxygen gas, or vital air, inhaled into the lungs; it does not appear proper, at the beginning of the fever; but, when the fymptoms of v debility come on, and the eruption aflumes a dark purple colour; then, I found a frequent exhibition of it to alter that appearance furprifingly. " When I firfl ufed the vital air, I prepared it from the black calx of manganefe; but finding the procefs took up more time than I could conveniently fpare, and obferving the difficulty there was, in inducing a patient to fit up in bed, to inhale it, I made ufe of the following method, which is much more fimple, ?nd anfwers equally well, without occafioning the patient any fatigue, or giving the attendants unneceflary trouble. " I firft caufed the doors and windows of the fick perfon's chamber to be clofed; and then, taking a chafing difh with fome live coals, throw into it half an ounce of purified nitre in powder, which immediately fills the room with a thick, white cloud, that continues wafting about for a confiderable time. " On examining a patient, during this operation, I never fail to find that it increases the pulfe; and, however low it may be, does, for a time, give it a degree of vigour and energy. In a fewminutes more, the difficulty of breathing diminilhes; the blood veffels of the cheeks and lips become of a more florid hue; and a gentle perfpiration breaks out on the {kin. " This procefs I direft to be frequently repeated, in the courfe of the day, and I have feldom feen it regularly perfevered in, without producing, decided benefit." An EJfay on the Analyjis of Mineral Waters. By Rich ARB Kirwan, Efq. F. R. S. &c. 8vo. pp.279. -London, Bremner.
Such is the well earned celebrity of Mr. K. as a chemift, that it is fuificient merely to announce the fubje?t and the author, in order to fecure readers.
The term mineral 'waters, is fpecially applied to fuch Waters only as are diltinguilhed by a peculiar colour, tafte, fmell, or other obvious property, from common fpring, lake, river, or other water, fitted for economical ufes. Mineral waters thus underltood, have long attracted the attention of mankind by their medicinal powers. Thefe, indeed, can properly be inferred only from their repeatedly experienced effects; yet, even with this reftrittion, the knowledge of their contents mail be deemed highly important, not only for the purpofe of imitating fuch as are found beneficial, in coun-, tries where Nature does not afford them, but alfo for the purpofe of difcovering the medical powers, and mode of action, of certain ingredients taken in a certain proportion, and a given degree of dilution, with a long train of confequences that may in time be deduced from this knowledge. There are alfo many other points of vie\v> in which an acquaintance with the contents of mineral Dr. Simmons's Medical Faffs andKOlservatisns. 563 neral waters muft be deemed of importance; and we are convinced that the fubjeft could not have fallen into more able hands.
The work is divided into Two Parts. In the firft part is contained an account, 1. Of fubftances found in mineral waters. 2. Of the tefts of thofe fubftances. The fecond part treats of the analylis of mineral waters, viz., I. Of the common method, by tefts, evaporations, cryitallization, folution, precipitation, &c. to each of which Mr. K. ftates his objections. 2. The new method, by determining the exiftence and quantity of elaftic fluids, by eftimating the folid and liquid ingredients. 3. The ufe of fpirits of wine in the analylis of mineral waters.
4. Tables, 1, of the quantities of real acid in mineral acids ; 2, of the quantities of acid abforbed by different bafes ; 3, of the quantity of each bafe abforbed by each acid ; 4, of the proportion of ingredients in neutral falts ; 5, of the length in feet of a column of common air at different barometrical heights and different temperatures. 5. Appendix, containing new experiments on various faline folutions.
The public are indebted for the prefent, as well as the former Volumes of this ufeful Publication to Dr. Simmons, a gentleman long eminent for his learning and abilities. As this colle&ion of papers holds an equal rank with the preceding, for curiofity as well as intereft, it will be in the hands of every perfon who is anxious for the improvement of medicine and furgery; little therefore need be faid in recommendation of it. This volume contains twenty-three papers, any of which might be felefted for the entertainment of our readers; but we choofe the following cafe, as it may tend to diffufe the knowledge of a remedy, for a very diftrelfing complaint, which may be eafily obtained and adminiftered by every one. " Ann Fuller, a fingle woman, aged forty-two years, has, at different times, in the courfe of the laft five or fix years, laboured under a fuppreffion of urine; and in fome of thofe attacks, no urine paffed from the kidneys to the bladder for ten or twelve days each time; the catheter having been repeatedly introduced to determine this faft.
, " In the years 1794 and 1795, fhe was confined to her bed feven months in a ftate of great agony. The pain extended acrofs the loins, and down the courfe of the urethra, and was frequently attended with violent and long continued vomiting of blood. In the courfe of this attack, the left ureter might be felt diftin&Iy in the groin, enlarged to the fize of an hen's egg, and extremely painful when preffed. This was evidently occauoned by the preflure of calculi, which fhe afterwards voided in great number, with blood in confiderabie quantities, frequently half a pint_at a time,, without any mixture of urine.
*' For her jrelief a variety of remedies was had recourfe to, fuch as itir. Pearson, on Lues* as repeated Weeding and warm bathing, faline purgatives, emetics of different kinds, camphor and opium in large dofes, uva urfi^ mephitic alkaline water, &c. To the camphor, combined with opium, which brought on a copious diaphorefis, fhe was more than once indebted for a mitigation of her painful fymptoms. The mepiiitic alkaline water was tried repeatedly, in different forms, plain, and with additions, cold and Warmed, but it conflantly bccafioned pain of the ftomach and vomiting. " At length, the haematuria continuing, accompanied with a good deal of pain, and every remedy that had been adminiftered hav-' ing failed to relieve her effe&ually, Mr. Gabriel Allen, my affiftant, fuggefted to me a trial of a decoftion of peach leaves, from which he had occafionally feen good effedts in cafes of nephritis. He was firft led, it feems, to the ufe of this remedy by a perfon, not of the medical profeffion, who was much reforted to by patients labouring under complaints of this kind, and who made a very fuccefsful ufe in fuch cafes, of an ele&uary, compofed of honey, and peach leaves dried and powdered ; together with a decodtion or infufion of the leaves. " After having feen fo many other remedies fail in this cafe, I was anxious to try the effeft of this new medicine. I fay ne<w, for although,different writers on the materia medica, mention the anthelmintic properties of the .leaves, and likewife of the flowers, of the peach tree, I do not find that any of them have noticed their effefts in affe&ions of the urinary pafTages. " A deco&ion was accordingly prepared, by boiling an ounce of dried leaves of the peach tree, (Amygdalus Perjica, Linn.) in a quart of water, till it was reduced to a pint and a half. Of the ftrained liquor fhe took a pint daily, and at the end of thirty hours after fhe began the ufe of this remedy, lhe voided clear natural urine, and in a few days recovered. " From that time fhe has conftantly kept by her a quantity of the dried leaves, and on the leaft return of the fymptoms has had recourfe td the decoftion again. Since that period, fhe has had feveral flight returns of gravel, and has even paffed fome fmall calculi, but fhe has had no return of the hematuria. Her prefent comfortable ftate of health fhe attributes to the ufe of the decoction of peach leaves; at any rate, it feems to be deferving of a trial in fimilar complaints. I have tried it in a variety of inftances befides the one which is more particularly the fubjett of the prefent letter, and I am deceived if it is not a medicine of considerable efficacy in complaints of this kind. Mr. Pearson, on Lues. 5^5 minds of thofe, whofe opinions have been unfettled on the treatment of the Venereal Difeafe, fmce the introdu?tion of the rlew remedies.
The fituatioh the refpe&able author has long~"iie~td> gives him full claim to the confidence of the public; and the work evidently fhews, that it is the, production of a mind well adapted for careful obfervation and found judgment. The author has given us a candid, examination and eftimate of thfe confidence to be placed in the eifedls of the lignum guaiaci, radix china, radix farfaparilla, mexereum, .cinchona, opium, cicuta, faffafrafs, juniperus, bardana, faponaria, dulcamara, jugletns, lobelia fyphilitica, ajlragalus exfcapus, ammonia prap arat a, terra ponder of a falita, certain preparations of mercury, mercurial fumigations, and 'vitriolic, marine, and nitrous acids. In the chapter where the author inquires into the ill effects that fometimes attend the exhibition of mercury, we feledl with pleafure, the following juft and manly remarks. " Indeed, I am fo far from feeling alarmed or perplexed, at the ?examples, of ill fuccefs which occafionally attend the exhibition of mercury, or from confidering thefe mifadventures as refle&ing difparagement or difgrace on that mineral, that I am rather furprifed at the fuccefs which fo often attends the indifcriminate ufc of it.
(f There is a defcription of men who fcatter abroad their crudities very liberally, in compendiums and elTays; a clafs of produ&ions, feldom calculated to convey information, but principally deiigned to perform the office of a midwife, by bringing their compilers into public view. With the fpurious intelligence colle&ed from thefe retailers of fcraps, many people furnifh themielves with a ftock fufficient to undertake the cure of their own complaints ; and, not uncommonly, impart the precious commodity to others who are lefs learned than themfelves. " That mercury, conduced by men of fuch endowments, fliould often fail of doing good, nay, that it (hould frequently infli?t great mifchief, would be according to the natural order of things: but, that it {hould ever prove finally beneficial, ought certainly to redound to the credit of a medicine, whofe falutary agency cannot be invariably fruftrated by all the blunders of hardy ignorauce.
" He who fhall difcard all general rules, becaufe they admit exceptions, ought likewife, for the fake of confiftency, to renounce all fcience, becaufe human knowledge is fallible and imperfedh " My opportunities of adminiftering mercury, have not ex-. tended to lefs than twenty thoufand cafes ; and I feel myfe'lf fully authorifed to aflert, that it is a remedy always to be confided in, Under every form of lues venerea; and, where we have only that one difeafe to contend with, that it is a certain antidote, and as fafe in its operation as any other adtive medicine, drawn from the vegetable, or the mineral kingdom. Let me not be mifunderftood here, as if I meant to fay, that it is a certain and fafe remedy in the hands of any one who undertakes to difpenfe it.
Quite the contrary for a multitude of inditputable proofs might Numb. XVI.
Dddd be tulminifttfring mercury, which fhall neverthelefs be infuflicient to fecure the conftitution. 3. The muriated barytes, and two of the mineral acids, when given to venereal patients, have the power of fufpending, for a limited time, the progrefs of the difeafe, and of removing many fecondary fymptoms; but they are not equal to the fubd'uing of the virus, and freeing the conftitution entirely from the effedts of that deftrudtive malady. They may likewik be employed with great advantage in thofe phagedenic ulcers of the genitals, and of the groin, which may be claffed among the fequelae of fyphilis. " 4. The nitric and nitrous acids have removed both the primary and fecondary fymptoms of fyphilis ; and, in fome inftances, it feems, that the former have not reCurred, nor have fecondary fymptoms appeared, at the period they commonly ftiew themfelves, when the cure has been imperfedt. But, as far as my own experience extends, and that of many refpedtable friends, who are connedted with large hofpitals, a permanent cure has never been accomplilhed by thefe acids, where fecondary fymptoms have been prefent.
*' The fame acids, when exhibited with the utmoft care and attention to many patients labouring under the primary fymptoms of the venereal difeafe, and where they have agreed perfedtly well with the ftomach, have been neverthelefs, found inadequate to the cure of thofe fymptoms. Indeed, the failures which have occurred, both in my own practice and that of many of my furgical friends, have been fo numerous, that I do not think it eligible to rely on the nitrous acid, in the treatment of any one form of the lues venerea. " But, while I am obliged thus to detradt from the fuppofed merits of the nitrous acid as an antidote againft lues venerea, I would by no means wifli to fee it exploded as a medicine altogether ufelefs in that difeafe. " Where an impaired ftate of the conftitution renders the introduction of mercury into the animal fyftern inconvenient, or evidently improper, the nitrous acid will be found capable of reftraining the progrefs of the difeafe, while, at the fame time, it will improve the health and ftrength of the patient. On fome occafions, this acid may be given in conjun&ion with a courfe of mercurial inundtion ; and it will be found to fupport the tone of the ftomach; to promote the appetite; to determine powerfully to the kidneys, and to counteract in no inconfiderable degree the effedts of mercury on the mouth and fauces.
Thefe advantages are by no means unimportant; and certainly entitle the gentlemen who have been adtive in promoting the introduction of this acid into general pradtice, to the gratitude of the public. " I will not prelume, however, to aflert, that we have yet learnt all that can be known, of the beft mode of exhibiting this medicine; nor will i fuppofe that we have arrived at the ne plus ultra of its virtues. Yet, in the prefent ftate of our information D d d d 2 upon upon tliis fubjeft, it would by no means be warrantable to fub* ftitute the nitrous acid in the place of mercury, for the cure of* venereal complaints; nor to permit the knowledge we have gained refpe&ing fome ufeful properties of the former, to feduce us to reieft what a long courfe of experience has taught us of the certain efficacy of the latter."